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dt)lg <br /> ■.5.----_- Application for Exemption FORM <br /> Nebraas�kaDepartment of <br /> REVENUE ENUE from Motor VehicieTaxes by Qualifying Nonprofit Organizations 45 T <br /> _,• •To be filed with your county treasurer. <br /> .--_� --_—_.—� •Read instructions on reverse side. <br /> Ape/cants Nano Type of Ownership <br /> TRINITY LUTHERAN CHURCH 0 Nonprofit <br /> Street or Other Mailing Address I County Corporaaon <br /> 212 W 12TH ST I HALL cute <br /> City State Zip Code I State Wham incorporated U (,por,Ky): <br /> GRAND ISLAND NE 68801 i NE ..__.._._._._.__.- <br /> IDENTIFY OFFICERS,DIRECTORS,OR PARTNERS OF THE NONPROFIT ORGANIZATION <br /> Tito I Name.Address.Gay State,zo Cods <br /> CO511?1nf1N_0 nawey dAAS 11_3040 e . !411—6-EI D---IsCwloa a6 ....--- <br /> (.14c.Lf . ._.c4ttiz . 8vE.P.� SDu-?aI 6 tlA IS/i1•Jb MF. ./�K�'aL, ,--- ----- <br /> -r lsuw-F_g— nom) St-Gel- 'i19 tr s ter £ w m.n Roma!) v hF,FDI <br /> clfRtn MAN of -Mu -rr,ES ILWKlV UVll-TDNJ - 2,36 & AIVOPY RD 4P-MND Icy NE 14105 <br /> DESCRIPTION OF THE MOTOR VEHICLES <br /> •Attach an additional sheet If necessary. <br /> { I Registration Date or <br /> Motor Vehicle Make I Model Year Body Type Vehicle ID Number Date of Acquisition, <br /> .....--.—.--_-_._-._ i __-. __..—�.._._......___.—._._ .—.--i_ it Newly-- -....---Purchased _ <br /> -ECG -.-__ _--- I 2 0I D —.-.,Calti l WIN (!11512 1 2.EA1=_ti Fs7, iliil M k- <br /> bebc — I 1995 gam WAGOU 12551NB3522SKb IYfbD <br /> I <br /> i <br /> I I <br /> I Tt N —t- -- <br /> Exempt Uses of Motor Vehicle: 1 Are the motor vehicles used exclusively <br /> as indicated? <br /> 0 Ag rculturat94orticulturaf Miducational iligeltfous 0 [-I Cemetery <br /> � <br /> Give detailed description of use,including an explanation it multiple use classifications exist: 1 t.fy dES i IRO <br /> USED FOt2. TP-ANSPORTIN6 ({,IuW4 Ai40 SCrlooI- Mean 66 k.S ill No,give petcentag3 of exempt use: <br /> I <br /> FOR- ACTIVITIES <br /> I <br /> Under penalties of taw,,I declare that I have examined this applicatan and that it S,to the best of my knowledge and billet,true complete,and corrtct.I <br /> also declare that Ian duly authorized to sign this exemption appricatIon,and that the organization owning the above-te!ed property does not discriminate <br /> (in membership or employment based on rata color,or national origkn. <br /> hhere )*'7 W I J'I J o BUSINESS hiliNA&@L Ilig 117 <br /> ere )*Authorized Signature Title Date <br /> L. `—�- FOR COUNTYTREASURER RECOMMENDATION _-_ i <br /> / — — , .4452-5: .a 77-.�>o.2. <br /> L APPROVAL COMMENTS i��•a•`"'T <br /> ❑DISAPPROVAL RECEIVE_.------ --------------,--7 ------- --------------------------- <br /> 2 _f, i eoe AQ-aer / 7 <br /> NOV 1 4 2017 of County r Date <br /> FOR COON y BOARD OF EQUALIZATION USE ONLY <br /> HALL COUNTY <br /> APPROVAL GRAND ISLANDS NEBRASKA <br /> MENrS: <br /> N. <br /> [I DISAPPROVAL r. <br /> or <br /> .-----_--._._ 1_y1 <br /> Aufho' -.Signature Date <br /> NeMaske oapanne t a Revenue Authorized by Neb.Rod Slat f i7 7-202f1KG)and(d).and 803,185.and 60-3.109 <br /> 96-253.2.006 Rat a-2011 Steeraeees 98.23.2006 Rev 52009 <br /> PLEASE RETAIN A COPY FOR YOUR RECORDS. <br />